BACKGREOUND: Several formulas for estimating allowable pre-transfusion blood loss were used to reduce unnecessary intraoperative blood replacement. The postoperative predicted hematocrit computed by formula was compared with the actual hematocrit and was tested which formula was more accurate in spine surgery. METHOD: Total blood volume was estimated in spine surgery of 34 patients. The target hematocrit (Hct) was suggested on 30% and the allowable blood loss was computed using the formula 1 and 2. For each patients, simultaneous measurement of blood loss and Hct was obtained at the end of operation. The postoperative predicted Hct by the formula 1 and 2 was calculated and compared with the actual Hct, and the difference between the formula 1 and 2 was evaluated. Allowable blood loss=Estimated blood volume (Initial Hct Target Hct)/Initial Hct ... Formula (1) Allowable blood loss=Estimated blood volume (Initial Hct Target Hct)/Average Hct ... Formula (2) RESULTS: 1) The preoperative Hct was 40.7 3.9%. The postoperative predicted Hct by the formula 1 and 2 were 34.3 4.6 and 34.9 4.3% respectively. The postoperative actual Hct was 30.1 4.6%.2) The difference between the predicted Hct by the formula 1 and the actual Hct was 4.2% (P<0.05). The difference between the predicted Hct by the formula 2 and the actual Hct was 4.8% (P<0.05). The difference between the predicted Hct by the formula 1 and 2 was 0.6% (P<0.05). It was thought that the predicted Hct by the formula 1 was more closer to the actual Hct. CONCLUSIONS: The predicted Hct by both formulas is underestimated when the results compare with the actual Hct. But the predicted Hct by the formula 1 provides a closer results to the actual Hct than the predicted Hct by the formula 2.
Blood Volume ; Hematocrit* ; Humans ; Spine

No abstract available.
Rectal Prolapse*

BACKGROUND: The induced hypotensive anesthesia may produce serious complications related to central nervous system, heart, liver, kidney and eyes. In this study, the blood loss during and after operation were compared to evaluate the delayed effect of hypotension on postoperative bleeding and also, the urine output was measured in control group and furosemide treated group, to investigate the effect of furosemide on the protection of kidney function. METHODS: Forty patients undergoing spinal surgery were evaluated and the hypotension was induced by the combination of hydralazine, esmolol and propranolol under enflurane anesthesia. During hypotensive anesthesia, the systolic arterial blood pressure was maintained between 65 to 75 mmHg. I compared the arterial blood gas analysis, plasma protein, albumin and calcium level, blood urea nitrogen (BUN), creatinine and complete blood count (CBC) before, durng and after hypotensive anesthesia. And also, the volume of blood loss and the units of transfused blood were measured intraoperatively and postoperatively. To investigate the effect of furosemide on the protection of kidney function, patients were randomly divided to contol group (n=20) and furosemide group (n=20). In furosemide goup, 0.1 mg/kg was administered intravenously and the urine output was measured during and after hypotensive anesthesia in both groups. RESULTS: The systolic arterial blood pressure during hypotensive anesthesia was maintained between 65 to 75 mmHg as planned in all forty patients. The average blood loss during and after operation were 769+/-541 and 786+/-397 ml, respectively and the average total blood loss was 1555+/-784 ml. The average units of transfused packed red cell during and after operation were 2.6+/-0.8 and 1.9+/-0.4 units, respectively, and the average total transfused units were 2.3+/-0.8 units. In both control and furosemide treated groups, all forty patients showed oliguria during first two hours after starting hypotensive anesthesia but urine outputs were recovered after the end of hypotensive anesthesia in both groups. During and after hypotensive anesthesia, pH was slightly but significantly decreased. Plasma protein, albumin, calcium and BUN were decreased during and after hypotensive anesthesia compared with before hypotensive anesthesia values. During and after hypotensive anesthesia, platelet count was decreased significantly but white cell count was increased. Severe oliguria was noted during hypotensive anesthesia in both groups and no serious complication related to hypotensive anesthesia was found. CONCLUSIONS: In this study, the volume of blood loss after anesthesia was almost same as that during anesthesia. And the administration of furosemide 0.1 mg/kg did not prevent oliguria during hypotensive anesthesia.
Anesthesia* ; Arterial Pressure ; Blood Cell Count ; Blood Gas Analysis ; Blood Urea Nitrogen ; Calcium ; Cell Count ; Central Nervous System ; Creatinine ; Enflurane ; Furosemide* ; Heart ; Hemorrhage ; Humans ; Hydralazine ; Hydrogen-Ion Concentration ; Hypotension ; Kidney ; Liver ; Oliguria ; Plasma ; Platelet Count ; Propranolol

No abstract available.
Colorectal Neoplasms*

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce an ischemic damage on liver. The purpose of this study is to evaluate postoperative liver function according to the degree of induced hypotension in spine surgery. METHODS: Sixty patients were classified into three groups. In group 1 (n=20) undergoing simple laminectomy, the systolic blood pressure (SBP) was maintained at 120 to 100 mmHg with controlling the concentration of enflurane. Hydralazine and/or esmolol were given to maintain the SBP at 100 to 80 mmHg in group 2 (n=20) and 80 to 60 mmHg in group 3 (n=20) as needed. Preoperative and postoperative 1, 3, 5, 7 day's serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and postoperative SGPT levels were increased significantly on postoperative 7 day only. In group 2, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and there was no significant difference between preoperative and postoperative SGPT levels. In group 3, postoperative SGOT levels were increased significantly on postoperative 1, 3 day and postoperative SGPT levels were increased significantly on postoperative 3, 5, 7 day. There was no significant difference among three groups in SGOT and SGPT levels. Postoperative ALP levels were decreased on postoperative 1, 3, 5, 7 day in all groups and there was no significant difference among three groups except a significant difference between group 1 and 3 on postoperative 1, 3 day in ALP levels. CONCLUSIONS: These results suggest that severe reduction in SBP at 80 to 60 mmHg by hydralazine and/or esmolol under general anestheia with enflurane can not exclude the possibility of liver damage.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Blood Pressure ; Enflurane ; Humans ; Hydralazine ; Hypotension ; Laminectomy ; Liver* ; Pyruvic Acid ; Spine*

Heat Shock Protein (HSP) is a genetic product reacting on stress. HSP is increased by physiological or environmental stress and expressed at gastrointestinal tumors such as stomach cancer, pancreatic cancer and large intestinal cancer, and at other various tumors such as lymphoma and breast cancer. The role of HSP is to interrupt the process of apoptosis interfering with formation of tumors, and weaken function of tumor control beyond that of immune surveillance. In case of causing the normal p53 to be mutated, it leads to morphological change of p53 protein and combine with HSP. But, it has not been clarified yet. We intend to examine the meaning of HSP 70 in bladder tumor by investigating the relations among HSP expression and tumor stage, tumor grade, P-gp (glycoprotein) expression as a product of multi-drug resistant gene, and p53 expression in 59 cases of bladder tumor. 1) There were HSP expressions of 8 cases (22%) among 36 superficial bladder tumors and of 9 cases (39%) among 23 invasive bladder tumors. 2) HSP positive reactions were observed in 1 case (8%) of 13 Grade I, and 6 cases (29%) of 21 Grade II and 10 cases (40%) of 25 Grade III. 3) Positive reactions of HSP were showed in 10 cases (40%) among 25 P-gp expression, and in 7 cases (21%) among 34 P-gp non-expression. 4) The p53 proteins were expressed in 12 cases (29%) among 42 ones of HSP non-expression and in 8 cases (47%) among 17 ones of HSP expression. 5) Positive reactions of HSP were showed in 9 cases (23%) among 39 ones of p53 non-expression, and in 8 cases (40%) among 20 ones of p53 expression. 6) 5 patients of 6 with negative expression of HSP and strong positive expression of p53 had poorly differentiated transitional cells, in which one of the patients accompanied with lung metastasis. In view of above study, HSP expression has no correlation with P-gp and stage in bladder tumor, but it has probable pertaining to tumor grade and p53. As it were, tumor cellular differentiation and p53 expression have weak correlations with HSP 70 expression. Meanwhile, judging from poor differentiation, in most cases of HSP non-expressed but p53 strongly expressed, HSP is insufficient to be a prognostic factor of bladder tumor independently, however, in case of using it, as supplementary one, concurrently with p53, it would be valuable prognostic factor in bladder tumor.
Apoptosis ; Breast Neoplasms ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Humans ; Intestinal Neoplasms ; Lung ; Lymphoma ; Neoplasm Metastasis ; P-Glycoprotein ; Pancreatic Neoplasms ; Stomach Neoplasms ; Urinary Bladder Neoplasms* ; Urinary Bladder*

The fibromatosis is a rare timorous with local invasion, but is not metastasized distantly. This term should not be applied to nonspecific reactive fibrous proliferations that are part of an inflammatory process of are secondary to injury of hemorrhage and have no tendency toward growth or recurrence. It arises principally from the connective tissue of muscle and overlying fascia or aponeurosis (musculoaponeurotic fibromatosis), and chiefly affects the muscle of shoulder, pelvic girdle, and extremity. The term 'aggressive fibromatosis' is also employed to describe this disease, but it is impossible to predict the clinical course in the individual case. The fibromatosis arising in the mediastinum is very rare, and the report about it is nearly absent. The plain radiography shows merely mass with soft tissue density. The CT demonstrates a poorly defined homogenous or heterogeneous mass, isodense with skeletal muscle on precontrast-images, and slightly hyperdense to muscle on postcontrast-scan. Accurate delineation between the tumor & surrounding tissue is vague or frequently impossible. The authors experienced one case of the mediastinal fibromatosis recently and report the case with review of concerned literature.
Connective Tissue ; Extremities ; Fascia ; Fibroma* ; Hemorrhage ; Indonesia ; Mediastinum ; Muscle, Skeletal ; Radiography ; Recurrence ; Shoulder

BACKGROUND: This study was performed to evaluate whether the degree of hypotension influences blood loss during spinal surgery. METHOD: Fifty patients undergoing only one level spinal fusion were assigned to one of three groups. In group 1 (n = 14), the systolic blood pressure (SBP) was maintained at 100 120 mmHg with enflurane. In groups 2 (n = 18) and 3 (n = 18), the SBP were maintained at 80 100 and 60 80 mmHg, respectively. Hydralazine and esmolol were used in the hypotensive groups. RESULTS: Blood losses during operation in groups 2 (554 +/- 287 ml) and 3 (456 +/- 162 ml) were significantly lower than in group 1 (1141 +/- 690 ml) (P < 0.05), although there was no significant difference between groups 2 and 3. The percentage of patients receiving transfusions during the operation in groups 1 and 2 were 57.1 and 5.6%, respectively. CONCLUSIONS: The results show that a moderate reduction in SBP (80 - 100 mmHg) reduces blood loss by more than half in comparison to a mild reduction in SBP (100 - 120 mmHg). However, a severe reduction in SBP (60 - 80 mmHg) does not increase the reduction in blood loss in comparison to moderate hypotension.
Blood Pressure ; Enflurane ; Humans ; Hydralazine ; Hypotension* ; Spinal Fusion

The Mapleson type D is one of the non-rebreathing systems used in pediatric general anes- thesia. Because it doesnt have soda lime, the fresh gas tlow (FGF) must be adjusted to the patient's size, body temperature and the anesthetic technique to prevent CO2 retention. We have used the FGF of 2-3.5 L/min according to patient's body weight, whether or not the patient has a fever. So, we examined arterial blood gas analysis in 3 pediatric patients with fever. We suggest that if a patient has a fever, it is desirable to inmease FGF to 5 L/min to prevent CO2 accumulation or acidosis.
Acidosis ; Blood Gas Analysis ; Body Size ; Body Temperature ; Body Weight ; Fever ; Humans

No abstract available.
Colon* ; Diverticulitis*